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PubMedDate not supplied

Exposure to formaldehyde among animal health students.

The objective of the present study was to evaluate the exposure to formaldehyde in 2 groups each with 18 students in animal health technology from two different training centers (TC) during a 3-hour weekly laboratory session in biology. Personal sampling during the session was done with passive bubblers for formaldehyde. The analysis of formaldehyde was done by visible absorption spectrometry according to NIOSH method 3500. The students in TC 1 were exposed to formaldehyde levels ranging from less than 0.11 to 0.76 mg/m3 with an average at 0.25 mg/m3 during the 3-hour biology laboratory. The students in TC 2 were exposed to higher concentrations of formaldehyde ranging from 0.26 to 1.2 mg/m3 with an average at 0.632 mg/m3. The results of the survey indicate that the students in both centers were exposed to a notable amount of formaldehyde vapor, at a level that is above the threshold limit value.

Adult↗
PubMed2004

Risk ritual and the management of control and anxiety in medical culture.

Medical culture in advanced technological societies is characterized by an abundance of warnings about health hazards, along with an equally abundant flow of prescriptive advice for protecting individuals against them. Knowledge of health hazards also defines living and working environments and has spawned a politics of regulatory control. These features of contemporary health consciousness and action, along with deepening insecurities in the larger body politic, precipitate a spiral of anxiety and control. The spiral disrupts the presumed security derived from medical knowledge and medically informed behaviors and threatens to erode the boundaries of sanctioned action for health protection. In the context of the volatile political economy of health, the spiral, with its excesses of anxiety and demands for unauthorized controls, elicits efforts to contain it. I explore the symbolic dimensions of risk, what I call 'risk ritual'--the prevailing form of managing this troublesome contradiction.

Anxiety↗
PubMed2000

[Management of technology in intensive care].

The lives of hospitalized patients depend on diagnostic-therapeutic procedures and on the care provided by the health team. It also depends on the quality and availability of factors such as: physical structure and material and human and financial resources. The need to optimize these resources and re-establish patients' health has brought about the Intensive Care Units (ICU), whose design must consider the physical environment and clinical equipment which are indispensable in health care. Aiming at identifying the level of knowledge of health professionals as to technical and operational information in equipment manuals and the perception of the interviewed professionals in relation to the adequacy of the physical and electrical installations of such units, we conducted a descriptive study in an ICU of a public hospital in Salvador, Brazil. The results show that such installations were considered to be unsuitable for the safe development of activities and that most of the health team members did not know the technical or operational specifications in the equipment manuals.

Adult↗
PubMed1995

Specialist training.

Specialist training must be reshaped to meet the challenges of new systems for the delivery of health care and rapid expansion in biomedical knowledge. An adequate and affordable supply of trained specialists and generalists able to deal with the health problems of populations served, is the responsibility of governments and policy-makers that fund and those who deliver graduate education. Clearly defined objectives for specialist training are needed, linked to planning for the medical workforce size. A balance between numbers of specialists and generalists is essential, although flexibility in programmes should allow individuals to change. Curricula for all specialties should be published. Strategies and methods for delivery of graduate education and training must be coherent with those of medical schools. Training should be planned and sequenced to meet the identified needs of individuals. Those who teach should themselves learn how to train and assess trainees. The location for training should reflect present and future clinical practice if disfunction between medical education and the health of populations served and their need is to be avoided. Specialist training should form the basis for continuing education by encouraging lifelong, evidence-based learning. Any reshaping of specialist training must be consistent with the continuum of medical education. Instruments for assessment of specialists in training have to be refined, based on action research. Ensuring mastery in the competencies of each component of the curriculum is essential. Those competencies will change in consequence of altered societal needs plus advances in technology and biomedical knowledge.

Education, Medical↗
PubMedDate not supplied

Role of the Biomedical Engineering Department in William Beaumont Hospital's technology assessment process.

Biomedical/Clinical Engineering Departments with expertise in engineering and technology management have a vital role to play in determining the potential for implementation and cost effectiveness of new medical technologies through technology assessment. Technology assessment offers the essential bridge between basic research and development and the prudent practical applications of medical technology. Because of the recent explosion of healthcare technologies, it is almost impossible for any single individual to stay abreast of these new technologies, much less provide an adequate assessment. To meet this need for comprehensive technology assessment, a multidisciplinary team approach is desirable. This paper deals with the assessment of medical technologies in a hospital environment and explores the possible roles biomedical engineering departments can play in the technology assessment process. It shares the experiences of the Biomedical Engineering Department of William Beaumont Hospital, a major, tertiary-care teaching institution currently involved in the technology assessment process utilizing a multidisciplinary team approach.

Biomedical Engineering↗
PubMed2001

Cascade effects of medical technology.

Cascade effect refers to a process that proceeds in stepwise fashion from an initiating event to a seemingly inevitable conclusion. With regard to medical technology, the term refers to a chain of events initiated by an unnecessary test, an unexpected result, or patient or physician anxiety, which results in ill-advised tests or treatments that may cause avoidable adverse effects and/or morbidity. Examples include discovery of endocrine incidentalomas on head and body scans; irrelevant abnormalities on spinal imaging; tampering with random fluctuations in clinical measures; and unwanted aggressive care at the end of life. Common triggers include failing to understand the likelihood of false-positive results; errors in data interpretation; overestimating benefits or underestimating risks; and low tolerance of ambiguity. Excess capacity and perverse financial incentives may contribute to cascade effects as well. Preventing cascade effects may require better education of physicians and patients; research on the natural history of mild diagnostic abnormalities; achieving optimal capacity in health care systems; and awareness that more is not the same as better.

Biomedical Technology↗
PubMed2002

Our wealth, our health--bellwether industries for decision tools and symbiotic stewardships.

This chapter examines the tea leaves of emerging technologies for the most fruitful areas of crossover value to health decisions, by spotting bellwether industries of similar information asymmetries. It examines changing tools and roles for growing consumer-centrism in personal finance, healthcare, private aviation, and law. It seeks to understand the technologies of managing and measuring, the transformations of growing transparencies in our processes, and how an increasing sense of collective stewardship forged between people and their machines can lead beyond effectiveness to wisdom, for individuals, communities, and the world. "The whole thing reminds me of the uncomfortable feeling I experienced when I first sought out investment advice. . . ..I concluded that I had to undertake the generalist's job myself; I had to take the high-level management of my investments into my own hands. Similarly, given the structure of the medical practice associated with prostate cancer, that's the only viable choice any patient has." Andy Grove, Co-Founder and Chair, Intel. "In the end, a symbiotic culture composed of human and digital individuals may be a more effective steward of the earth's resources than humans would be by themselves." Donald D. Chamberlin, author and ACM Fellow.

Biomedical Technology↗
PubMed2004

Laser,"closure", stents and other new technology in the treatment of venous disease.

New technology is transforming our approach to venous disease. Once considered taboo for fear of causing deep venous thrombosis, surgical or endovenous intervention in the deep venous system is now known to be safe. Newer techniques allow minimally invasive procedures, many carried out on an outpatient basis. Traditional conservative regimens to treat acute ilio-femoral DVT are yielding to more aggressive interventional approaches to minimize the high incidence of postthrombotic syndrome with the former. Stent technology can safely and effectively relieve many of the disabling symptoms of chronic venous obstruction. Stent patency is high and morbidity low. Knowledge of venous pathophysiology has also advanced, though much remains to be learned. The beneficiaries are the large patient population with DVT and chronic venous insufficiency, which is estimated to be at least three times as large as patients with arterial disease. Unlike arterial disease, venous pathology afflicts the younger working age population in large numbers at enormous direct and social costs. In the older patient, deep venous disease is common, but seldom suspected. The symptoms are often ascribed to systemic causes. A thorough venous investigation is the key to proper diagnosis and treatment. Often, a minimally invasive procedure such as EVLT or stent insertion can offer surprising symptom relief with significant improvement in the quality of life during the twilight years.

Angioplasty, Balloon, Laser-Assisted↗
PubMed2006

Gene technology based therapies in the brain.

Gene therapy potentially represents one of the most important developments in modern medicine. Gene therapy, especially of cancer, has created exciting and elusive areas of therapeutic research in the past decade. In fact, the first gene therapy performed in a human was not against cancer but was performed to a 14 year old child suffering from adenosine deaminase (ADA) deficiency. In addition to cancer gene therapy there are many other diseases and disorders where gene therapy holds exciting and promising opportunities. These include amongst others gene therapy within the central nervous system and the cardiovascular system. Improvements of the efficiency and safety of gene therapy is the major goal of gene therapy development. After the death of Jesse Gelsinger, the first patient in whom death could be directly linked to the viral vector used for the treatment, ethical doubts were raised about the feasibility of gene therapy in humans. Therefore, the ability to direct gene transfer vectors to specific target cells is also a crucial task to be solved and will be important not only to achieve a therapeutic effect but also to limit potential adverse effects.

Alzheimer Disease↗
PubMed2005

Assessing the potential economic value of health information technology interventions in a community-based health network.

Health information professionals recognize the need to demonstrate that the benefits of health information technological (HIT) interventions outweigh their costs. However, such cost-benefit analyses are rarely conducted for HIT interventions, due in part to the lack of a standard methodology. In this study, we describe how the U.S. Public Health Service's guidelines for health economic analyses can be used to evaluate HIT interventions. This framework is described in the context of an economic analysis we are conducting for three HIT interventions to be implemented in a community-based health network caring for Medicaid beneficiaries in Durham County, North Carolina. At present, the 17,779 patients in our study cost Medicaid more than $5 million per month. In sensitivity analyses, we demonstrate that if our information intervention redirects just 10% of low-severity emergency room encounters to outpatient encounters, it will result in $12,523 of monthly savings to the local health system.

Biomedical Technology↗
PubMed1991

An appraisal of the ethical issues involved in high-technology cancer pain relief.

... We will turn our attention to the current state of pain relief technology and the ethical questions surrounding the use of advanced technology, otherwise referred to as "high-tech," pain relief. It is obvious that pain may decrease the quality of life for cancer patients. The availability of long-acting narcotics, such as MS Contin or methadone, affords cancer patients long-duration pain relief at minimal cost. The use of adjuvant medications may also be important. Clinical examples of the effective use of adjuvant medications include the addition of a nonsteroidal, anti-inflammatory agent to help patients cope with bone pain and the use of a serotonin blocking agent to reduce the transmission of pain impulses in the spinal cord. Only a small percentage of patients are good candidates for high-tech delivery systems for narcotic administration. In our pain management clinic, all patients are initially placed on oral medications. When the side effects of oral medications become excessive, or the patient becomes unable to take oral medications, high-tech modalities are considered for use.

Altruism↗
PubMed2002

Matching resources to treatment decisions for patients with acute coronary syndromes.

Multiple dynamic forces are having an impact on the way cardiovascular disease is treated today and will be in the future. These forces include extended life expectancy, decreased disability, and accelerated improvement in the effectiveness of medical technology. All of these forces will lead to a predictable increase in health care costs. Cardiologists must also be cognizant of the rise in health care consumerism; patients are assuming a larger role in decisions about their medical care and treatment. All of these factors are driving the climate of evidence-based medicine, particularly in the cardiovascular field. Payers and the government are beginning to require the clinical community to define quality. In turn, these third parties are beginning to measure quality as defined by the profession and to hold providers accountable for the quality of what they do. Although the frontier of genetic prediction in therapeutics will serve as an intellectual focus for bringing these issues closer to the forefront in cardiovascular medicine, the fundamental provision of value in health care (high quality at reasonable cost) cannot wait on genomics. Because the amount of evidence in acute coronary syndromes (ACS) exceeds other areas of medicine, therapies for ACS will undergo increasingly intense scrutiny.

Acute Disease↗
PubMed2006

Lifeworld-led healthcare: revisiting a humanising philosophy that integrates emerging trends.

In this paper, we describe the value and philosophy of lifeworld-led care. Our purpose is to give a philosophically coherent foundation for lifeworld-led care and its core value as a humanising force that moderates technological progress. We begin by indicating the timeliness of these concerns within the current context of citizen-oriented, participative approaches to healthcare. We believe that this context is in need of a deepening philosophy if it is not to succumb to the discourses of mere consumerism. We thus revisit the potential of Husserl's notion of the lifeworld and how lifeworld-led care could provide important ideas and values that are central to the humanisation of healthcare practice. This framework provides a synthesis of the main arguments of the paper and is finally expressed in a model of lifeworld-led care that includes its core value, core perspectives, relevant indicative methodologies and main benefits. The model is offered as a potentially broad-based approach for integrating many existing practices and trends. In the spirit of Husserl's interest in both commonality and variation, we highlight the central, less contestable foundations of lifeworld-led care, without constraining the possible varieties of confluent practices.

Attitude to Health↗
PubMed2004

[Biostatistics contribution to the development of biomedical sciences].

Biostatistics can be defined as the science of data reduction methods, variability and populations, in the field of medicine and biomedical science. Its origins trace back to the work of Quetelet (1796-1874) and more recently of Fisher (1890-1962). Following the technological advances in biomedical sciences during the 20th century, modern biostatistics is facing the formidable challenge of translating information into knowledge. Biostatistics has significantly contributed to the development of biomedical sciences in many areas: laboratory medicine (reference values and quality control), randomized clinical trials (RCT), clinical decision-making, new drugs development. The explosion of scientific research over the past decades, however, has led to misuse and abuse of statistical methods. Common sense should therefore always prevail. In sum, biostatistics, an amalgalm of mathematics, logic and judgment, has given the quantitative and factual dimension that the evolution of biomedical sciences required.

Biomedical Technology↗
PubMed2000

The use of information technology in improving medical performance. Part I. Information systems for medical transactions.

Investment in medical information technologies reached $15 billion in 1996. However, these technologies have not had the wide impact predicted in streamlining bureaucracy, improving communications, and raising the effectiveness of care. In this series, we identify how such technologies are being used to improve quality and performance, the future directions for advancement, and the policy and research developments required to maximize public benefit from these technologies. Each of these articles focuses on a different type of information technology: (1) information systems to manage medical transactions; (2) physician-support technologies to improve medical practice; and (3) patient-focused technologies designed to change how people manage their own care. This first article of a 3-part series examines the successes of and opportunities for using advanced information systems that track and manage medical transactions for large populations to improve performance. Examples of such systems include: HEDIS, which gathers standardized data from health plans on quality of care; the USQA Health Services Research Program, which tracks treatment patterns and outcomes for 14 million insurance members; Ford's program to collect medical data for over 600,000 employees; and Harvard Pilgrim Health Care's system of computerized laboratory, pharmacy, ambulatory, and hospital admission records for its 1.5 million members. Data from these systems have led to modest improvements in knowledge and practice patterns for some diseases. Significant barriers are slowing efforts to add outcomes data to these databases and broaden the databases to cover larger populations. Nonetheless, existing data in currently evolving systems could be used to greater benefit in tracking public health and in identifying more effective treatments and causes of diseases.

Biomedical Technology↗
PubMed2005

[The new seniors. Sociological and medical aspects].

Medical progress has led to a spectacular increase in life expectancy. The world population is ageing in a context of rapid technological change destabilizing individuals and societies in their values and functions to such a point that it is Leading to a true change in civilization. Seniors have become important socio-economic players with a feeling of prolonged youth and autonomy. Globalization has generated a feeling of insecurity and a constantly growing need for more information. In the face of these changes, adaptation in rhythm ranges, according to the individual, from reticence in its extreme form, the principle of precaution, through fatalistic passivity to opportunistic enthusiasm. In the medical field, patients have access to all modern means of information, and the most well-informed tend to behave more or less consciously as healthcare consumers, modifying the relationship with doctors which may become a service provider-client type relationship. A new relation to the body and with others has appeared with desires and also performance obligations. The difficulties of adaptation to this complex and socially anxiogenic world are expressed by permanent social conflicts and the increasing recourse to individual psychotherapeutic support.

Aged↗
PubMed2001

Rapid DNA typing of HLA-B27 allele by real-time PCR using lightcycler technology.

For clinical diagnostic routine we developed a fast DNA typing of HLA-B27 by PCR and real-time detection using LightCycler technology. The method combines the sensitivity and specificity of PCR with the swiftness of the LightCycler system. The amplification step was performed with a primer set coding for a region in the third exon common to B*2701 to B*2705. The PCR cycles were monitored continuously using the SYBR Green I dye. Beta-globin was used as an internal control. An analysis of 32 samples with one PCR run was completed within 40 minutes. After amplification a melting curve analysis permitted the accurate identification of the PCR amplicons. The mean melting temperatures (Tm) were 90.5 degrees C and 87.3 degrees C, which are characteristic for HLA-B27 and beta-globin, respectively. A comparison of 300 samples which were typed for HLA-B27 with a conventional sequence-specific polymerase chain reaction (SSP-PCR) and with the new method demonstrated a perfect correlation (specificity 100%). In summary, the method described is fast, reliable, cost-effective and well adapted for routine laboratory testing.

Alleles↗
PubMed2004

Patient access to medical technology across Europe.

Access to medical technology differs across Europe. Differences in funding and reimbursement systems create barriers for the adoption of new and innovative medical technology. It is obvious that a joint effort between representatives from the industry and the profession has great potential to emphasise inequitable discrepancies and thereby improve the availability of accepted innovations in cardiovascular medicine. It is equally obvious that future efforts to overcome such restrictions to availability must be directed at the individual country level. The involvement of the profession, perhaps best accomplished by activation of National Cardiac Societies, will be mandatory for success. Collaboration with the industry is then a likely key factor for success. Presently there seems to be a great lack of knowledge and interest for this important aspect of a well functioning health care system and the responsibility to improve it remains with the professional societies. They need to allocate time and resources for this purpose, educate their members and lobby within their countries with the ambition to create better, more uniform and transparent procedures, and to become natural partners in the funding and reimbursement processes.

Biomedical Technology↗